The Effect of Dry Care on the Time of Umbilical Cord Separation in Newborns: A Systematic Review and Meta-Analysis

Abstract

There are many different approaches to umbilical cord care in clinical practice. Dry care is recommended by the WHO based on its ease of implementation and relatively low cost. However, the effect of dry care on the time of umbilical cord separation and related complications require further study. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dry care on the time of umbilical cord separation and related adverse events in newborns. A literature search was conducted of articles published before December 2021 in the Cochrane Library, PubMed, Medline, CINAHL, Embase, Airiti Library, and National Digital Library of Theses in Taiwan databases. The research quality of the identified articles was assessed using the Modified Jadad Scale. Statistical analyses were performed using Review Manager, version 5.3, with statistics reported as mean differences with 95% confidence intervals. Seven randomized controlled trials covering a total of 27,037 newborns were identified for analysis. Umbilical cord care in these studies included the following approaches: dry care, alcohol, chlorhexidine (CHX), mother's milk, and salicylic sugar powder (SSP). The results of the meta-analysis showed that umbilical cord separation time was significantly lower for the dry care approach compared to the alcohol approach (MD: -1.78 days, 95% CI: -2.4 to -1.16, three studies, n = 2,102) but not significantly different than the CHX approach (MD: -0.15 days, 95% CI [-1.99, 1.69], two studies, n = 10,519). Notably, the umbilical cord separation time for both mother's milk (MD: 1.19 days, 95% CI [0.82, 1.56], three studies, n = 730) and SSP (MD: 4.9 days, 95% CI [3.71, 6.09], one study, n = 92) approaches were reported as significantly less than the dry care approach. In addition, the CHX approach was associated with significantly fewer cord-related adverse events, while the alcohol, mother's milk, and SSP approaches were associated with rates of cord-related adverse advents similar to dry care. Because using dry care for umbilical cord care shortens the cord separation time compared to the alcohol approach and does not increase the incidence of omphalitis, this approach should be the first choice for cord care. Both mother's milk and SSP approaches are also associated with shorter umbilical cord separation times without adverse effects, and may be used as alternatives to dry care in umbilical cord care.